• Here ya'all go that cant pull it up , it does make sense

Finding hope in donations of 'excess' skin

Beverly surgeon takes lead in breakthrough for grafts

Dr. Beverly Shafer at her office in Beverly. (Robert Spencer for the boston globe)

By Kay Lazar, Globe Staff  |  July 26, 2007

Like an empty bag of skin. That's how Nina Esile describes the flab that protruded from her stomach to her pelvic area after four pregnancies -- including twins 13 years ago -- left her abdominal muscles severely damaged. The more Esile dieted and exercised -- she dropped 50 pounds over the past two years -- the larger her "bag of skin" became. It got to the point that the Newburyport software writer, a 44-year-old single mother of five, couldn't bear to look at herself in the mirror.

Then Dr. Beverly Shafer, a Beverly surgeon who was poised to repair Esile's abdomen and perform a tummy tuck in May, asked if she'd be willing to donate the large slab of skin about to be removed.

It never entered Esile's mind that the very flab that had caused her so much misery could be transformed into something that could help others. She eagerly signed on. Esile's "living" skin donation process was a first for Shafer, who has been a plastic surgeon for 17 years, and for Massachusetts, according to the Musculoskeletal Transplant Foundation, a New Jersey-based nonprofit organization that describes itself as the nation's largest tissue bank. Shafer is one of roughly 69 surgeons nationwide, and the only one in the state, now collaborating with the foundation on its nascent living skin program.

"I didn't want this skin," said Esile, a vivacious, now 150-pound pioneer. "Its like an old dress you hate and someone says, 'Oh, that's cool.' "

As the number of doctors nationwide seeking skin grafts for complex surgeries continues to grow, so, too, does their need for the precious tissue. The need for large grafts now exceeds the supply of skin available from deceased donors, said the transplant foundation. The shortage sent researchers on a yearlong mission to design a process for turning skin from living donors into usable grafts.

"The challenge with this skin is that even though patients have lost a lot of weight, the skin still had a lot of fat attached to it," said Martha Anderson, executive vice president of donor services at the foundation.

So scientists devised a method to remove all the fat when they removed the top layer of donated skin. They also get rid of the cells, leaving what is called a collagen matrix. Removing cells keeps a recipient's body from reacting to the graft as if it were foreign matter, which is a primary concern in organ transplants. The harvested skin is then implanted in patients whose bodies use this as a scaffolding to start rebuilding skin on their own, Anderson said.

"Recipients do not have to take antirejection drugs for living skin or deceased skin, because we have taken the cells out," Anderson said. "We don't have to do blood-type matching, either -- none of the matching you have to do with organs."

After the top layer is removed, the underlying skin, minus cells and fat, is cut and shaped into sections suitable for grafts, then packaged, frozen, and stored for distribution through the foundation.

Scientists, however, still are honing their techniques on the live-skin donations, because the surgical instruments typically used on cadavers don't work as well on pieces of live donated skin.

"We have not figured out the technology yet for how to take very thin pieces of skin from this skin," Anderson said. "Deceased persons' skin is easier to shave off because it's still attached to the body."

Skin from cadavers is ideal for use on burn victims because it is recovered in extremely thin sheets -- thinner than one ply of Kleenex, Anderson said. By creating a process to recover and use live donated skin, more skin from deceased donors will be available for burn victims, she said. The live-skin grafts can be used in a growing number of procedures, including breast reconstruction after mastectomy, abdominal wall repair for hernias, and bladder slings to control incontinence.

The foundation's first live-donor skin was recovered from a patient on Oct. 28, 2005, in Stratham, N.H. As of this month, the foundation has received a total of 326 donations, including Esile's.

While Esile did not undergo weight-loss surgery, the majority of live-skin donations come from patients who have undergone that procedure. Most have lost at least 100 pounds, and have large flaps of skin that need to be removed. Last year, an estimated 177,600 people in the United States had the surgery, according to the American Society for Metabolic and Bariatric Surgery.

The Musculoskeletal Transplant Foundation's mission to find a use for the discarded tissue also was driven by weight-loss patients, who increasingly were calling tissue banks and asking if they could donate their skin, said Scott Brubaker, chief policy officer for the Virginia-based American Association of Tissue Banks.

"We never had anyone to refer them to," he said.

For Shafer, the Beverly surgeon collaborating with the foundation, the potential uses for live skin grafts seem limitless.

"We are finding all new sorts of applications for this material," she said. "We are able to do much more fine reconstruction."

Shafer is hoping live skin grafts will be able to give a 90-year-old patient her smile back.

The woman lost part of her lips to skin cancer, and Shafer is planning to use layers of the material to rebuild her mouth.

Patients are neither paid nor charged for donating skin. The National Organ Transplant Act prohibits the buying and selling of organs or tissues of any kind.

"The wonderful thing about this is the patients who want to do this are the ones who are driving this," said Anderson, the foundation official. "We are grateful they want to make a difference in someone else's life."

For more information on the skin donation program, go to mtf.org.

Kay Lazar can be reached at [email protected].